Abstract No. 452: Single session management of SVC syndrome and complex central vein occlusion

Abstract

1) The reader will learn an algorithmic approach to single session treatment of extensive central vein occlusions in SVC Syndrome: i.e. techniques, tools, results and evidence. 2) To learn an approach to vein stenting: i.e. double barrel, end-to-side, bare vs. covered, single side and best sizing. Central vein occlusions (CVO) are common in end stage renal disease (ESRD) patients, due to chronic catheter use, and patients with thoracic malignancies. Symptoms include: facial, laryngeal, neck and/or upper extremity edema, and syncope. The exhibit will review existing literature of techniques and results to treating CVOs and provide case examples from review of 23 consecutive patients, who were diversely treated for SVC syndrome at a single academic institution. The proposed algorithm to single session treatment of CVO's will include description of patient procedural positioning, access site entry, procedural equipment and complex image guidance (i.e. sharp recanulization and echocardiography). Specific procedural techniques to treat single brachiocephalic, internal jugular, SVC occlusion and complex multi-vein occlusion of the SVC, brachiocephalic and internal jugular veins will be discussed and case examples presented. Diverse management strategies including a guide to catheter selection to maximize transversal of occlusions, balloon angioplasty, stenting (i.e. sizing, configuration, bare metal vs. covered), thrombolytic treatment with or without mechanical thrombolysis to achieve durable vessel patency in a single session will be presented. To present an algorithmic approach to endovascular management of SVC Syndrome, including a range of endovascular tools to allow a reliable single session treatment of a broad range of anatomic central vein occlusions.